Gastrointestinal Nursing

Introduction to Gastrointestinal Nursing

•Definition and Scope:

• GI nursing involves managing
patients with disorders affecting the
digestive system.
• Includes acute and chronic conditions
impacting the esophagus, stomach,
intestines, liver, pancreas, and
gallbladder.
2. Anatomy and Physiology of the GI System

 1.Upper GI Tract: MESD

• Mouth: Initial digestion with saliva and mastication.

• Esophagus: Transports food from the mouth to the
stomach via peristalsis.
• Stomach: Secretes gastric acid and enzymes for
digestion; involves mechanical and chemical
digestion.
• Duodenum: First part of the small intestine where
most digestion occurs; neutralizes stomach acid and
receives bile and pancreatic enzymes.
2. Lower GI Tract:
•Small Intestine:
• Jejunum and Ileum: Absorption of nutrients,
electrolytes, and water.

•Large Intestine:
• Cecum and Colon: Absorbs water and
electrolytes; forms and stores feces.
• Rectum and Anus: Control the expulsion of
feces.
3. Accessory Organs:
•Liver: Produces bile, processes nutrients,
detoxifies
substances, and synthesizes proteins.

•Pancreas: Produces digestive enzymes and

hormones
(insulin and glucagon) for glucose
regulation.

•Gallbladder: Stores and concentrates bile

produced
by the liver

https://youtu.be/MgVaBwniceU
What is the digestive system?
Your digestive system is a network of organs that help you digest
and absorb nutrition from your food. It includes your
gastrointestinal (GI) tract and your biliary system. Your GI tract is
a series of hollow organs that are all connected to each other,
leading from your mouth to your anus. Your biliary system is a
network of three organs that deliver bile and enzymes through to
your GI tract your bile ducts.
Gastrointestinal (GI) tract
The organs that make up your GI tract, in the order that they are
connected, include your mouth, esophagus, stomach, small
intestine, large intestine and anus.
Biliary system
Your biliary system includes your liver, gallbladder, pancreas and bile
ducts.

What does the digestive system do?

Your digestive system is uniquely constructed to do its job of turning your
food into the nutrients and energy you need to survive. And when it’s
done with that, it handily packages your solid waste, or stool, for disposal
when you have a bowel movement.
Why is digestion important?
Digestion is important because your body needs
nutrients from the food you eat and the liquids you
drink in order to stay healthy and function
properly. Nutrients include carbohydrates, proteins,
fats, vitamins, minerals and water. Your digestive
system breaks down and absorbs nutrients from
the food and liquids you consume to use for
important things like energy, growth and repairing
cells.
Mouth
The mouth is the beginning of the digestive tract. In fact, digestion starts before you even
take a bite. Your salivary glands get active as you see and smell that pasta dish or warm
bread. After you start eating, you chew your food into pieces that are more easily
digested. Your saliva mixes with the food to begin to break it down into a form your body
can absorb and use. When you swallow, your tongue passes the food into your throat and
into your esophagus.

Esophagus

Located in your throat near your trachea (windpipe), the esophagus receives food
from your mouth when you swallow. The epiglottis is a small flap that folds over
your windpipe as you swallow to prevent you from choking (when food goes into
your windpipe). A series of muscular contractions within the esophagus called
peristalsis delivers food to your stomach.
But first a ring-like muscle at the bottom of your esophagus called the lower
esophageal sphincter has to relax to let the food in. The sphincter then contracts
and prevents the contents of the stomach from flowing back into the esophagus.
(When it doesn’t and these contents flow back into the esophagus, you may
experience acid reflux or heartburn.)
Stomach
The stomach is a hollow organ, or "container," that holds food while it is being mixed with stomach enzymes.
These enzymes continue the process of breaking down food into a usable form. Cells in the lining of your
stomach secrete a strong acid and powerful enzymes that are responsible for the breakdown process. When
the contents of the stomach are processed enough, they’re released into the small intestine.
Small intestine ( dji )
Made up of three segments — the duodenum, jejunum, and ileum — the small intestine is a 22-foot long muscular
tube that breaks down food using enzymes released by the pancreas and bile from the liver. Peristalsis also works in
this organ, moving food through and mixing it with digestive juices from the pancreas and liver.
The duodenum is the first segment of the small intestine. It’s largely responsible for the continuous breaking-down
process. The jejunum and ileum lower in the intestine are mainly responsible for the absorption of nutrients into the
bloodstream.
Contents of the small intestine start out semi-solid and end in a liquid form after passing through the organ. Water,
bile, enzymes and mucus contribute to the change in consistency. Once the nutrients have been absorbed and the
leftover-food residue liquid has passed through the small intestine, it then moves on to the large intestine (colon).
1. Assessment
•Subjective Data: Collect information from the patient
about symptoms such as abdominal pain, nausea, vomiting, diarrhea,
constipation, changes in bowel habits, weight loss, or dietary changes.

•Objective Data: Gather physical findings through

inspection, palpation, percussion, and auscultation of the abdomen.
Look for signs like abdominal distension, tenderness, bowel sounds, or
changes in stool characteristics.

•Diagnostic Tests: Review results from tests such as blood

work, stool samples, endoscopies, X-rays, or CT scans to gain a
comprehensive understanding of the patient's condition.
2. Diagnosis
•Nursing Diagnoses: Identify nursing
diagnoses based on the assessment data.
• Common diagnoses in GI nursing might include:

• Acute Pain related to inflammation or

obstruction
• Imbalanced Nutrition: Less than Body
Requirements related to malabsorption or
decreased appetite
• Risk for Dehydration related to vomiting or
diarrhea
• Constipation related to medication use or
decreased physical activity
3. Planning

•Goals and Outcomes: Develop realistic and

measurable goals for the patient. For example, a goal might be
to reduce abdominal pain to a tolerable level within 24 hours
or to achieve regular bowel movements within a specified
timeframe.

•Interventions: Plan nursing interventions to address the

identified problems. For GI issues, this might include:
• Administering medications as prescribed (e.g.,
antiemetics, laxatives)
• Providing dietary recommendations or modifications
• Educating the patient about symptoms to watch for and
when to seek further care
• Monitoring vital signs and fluid intake/output to prevent
complications like dehydration
3. Planning

•Goals and Outcomes: Develop realistic and

measurable goals for the patient. For example, a goal
might be to reduce abdominal pain to a tolerable level
within 24 hours or to achieve regular bowel movements
within a specified timeframe.

•Interventions: Plan nursing interventions to

address the identified problems. For GI issues, this might
include:
• Administering medications as prescribed (e.g.,
antiemetics, laxatives)
• Providing dietary recommendations or
modifications
• Educating the patient about symptoms to watch
for and when to seek further care
• Monitoring vital signs and fluid intake/output to
5. Evaluation

•Assess the Outcomes: Evaluate the effectiveness of

the interventions based on whether the goals were met. For
instance, if the goal was to relieve pain, assess whether the
patient reports a decrease in pain level.
•Adjust the Plan: Modify the care plan based on the
patient’s progress, any new issues that arise, or changes in the
patient’s condition.
What are some common conditions that affect the digestive system?

- Temporary conditions and long-term, or

chronic, diseases and disorders that affect
the digestive system.
- It’s common to have conditions such as
constipation, diarrhea or heartburn from time
to time.
- If you are experiencing digestive issues like
these frequently, be sure to contact your
healthcare professional.
- It could be a sign of a more serious disorder
that needs medical attention and treatment.
Short-term or temporary conditions that affect the digestive system
include:  Constipation: Constipation generally happens when you go poop (have a bowel movement) less
frequently than you normally do. When you’re constipated, your poop is often dry and hard and
it’s difficult and painful for your poop to pass.

 Diarrhea: Diarrhea is when you have loose or watery poop. Diarrhea can be caused by many
things, including bacteria, but sometimes the cause is unknown.

 Heartburn: Although it has “heart” in its name, heartburn is actually a digestive issue. Heartburn
is an uncomfortable burning feeling in your chest that can move up your neck and throat. It
happens when acidic digestive juices from your stomach go back up your esophagus.

 Hemorrhoids: Hemorrhoids are swollen, enlarged veins that form inside and outside of your
anus and rectum. They can be painful, uncomfortable and cause rectal bleeding.

 Stomach flu (gastroenteritis): The stomach flu is an infection of the stomach and upper part of
the small intestine usually caused by a virus. It usually lasts less than a week. Millions of people
get the stomach flu every year.

 Ulcers: An ulcer is a sore that develops on the lining of the esophagus, stomach or small
intestine. The most common causes of ulcers are infection with a bacteria called Helicobacter
pylori (H. pylori) and long-term use of anti-inflammatory drugs such as ibuprofen.

Gallstones: Gallstones are small pieces of solid material formed from digestive fluid that form in your
gallbladder, a small organ under your liver.
Common digestive system diseases (gastrointestinal diseases) and
disorders include:

 GERD (chronic acid reflux): GERD (gastroesophageal reflux disease, or chronic acid reflux) is a
condition in which acid-containing contents in your stomach frequently leak back up into your
esophagus.

 Irritable bowel syndrome (IBS): IBS is a condition in which your colon muscle contracts more or
less often than normal. People with IBS experience excessive gas, abdominal pain and cramps.

 Lactose intolerance: People with lactose intolerance are unable to digest lactose, the sugar
primarily found in milk and dairy products.

 Diverticulosis and diverticulitis: Diverticulosis and diverticulitis are two conditions that occur in
your large intestine (also called your colon). Both share the common feature of diverticula,
which are pockets or bulges that form in the wall of your colon.

 Cancer: Cancers that affect tissues and organs in the digestive system are called gastrointestinal
(GI) cancers. There are multiple kinds of GI cancers. The most common digestive system cancers
include esophageal cancer, gastric (stomach) cancer, colon and rectal (colorectal)
cancer, pancreatic cancer and liver cancer.

 Crohn’s disease: Crohn’s disease is a lifelong form of inflammatory bowel disease (IBD). The
condition irritates the digestive tract.

 Celiac disease: Celiac disease is an autoimmune disorder that can damage your small intestine.
The damage happens when a person with celiac disease consumes gluten, a protein found in
wheat, barley and rye.
Care
How can I keep my digestive system healthy?
If you have a medical condition, always ask your healthcare provider what you should do and eat to
stay healthy and manage your condition. In general, the following are ways to keep your digestive
system healthy:
 Drink water often: Water helps the food you eat flow more easily through your digestive system.
Low amounts of water in your body (dehydration) is a common cause of constipation.
 Include fiber in your diet: Fiber is beneficial to digestion and helps your body have regular bowel
movements. Be sure to incorporate both soluble and insoluble fiber into your diet.
 Eat a balanced diet: Be sure to eat several servings of fruit and vegetables every day. Choose whole
grains over processed grains and try to avoid processed foods in general. Choose poultry and fish
more often than red meat and limit all deli (processed) meats. Limit the amount of sugar you
consume.
 Eat foods with probiotics or take probiotic supplements: Probiotics are good bacteria that help
fight off the bad bacteria in your gut. They also make healthy substances that nourish your gut. It
can be especially helpful to consume probiotics after you have taken an antibiotic because
antibiotics often kill both bad and good bacteria in your gut.
 Cont……
 Eat mindfully and chew your food: Eating slowly gives your body time to digest
your food properly. It also allows your body to send you cues that it is full. It is
important to chew your food thoroughly because it helps to ensure your body has
enough saliva (spit) for digestion. Chewing your food fully also makes it easier for
your digestive system to absorb the nutrients in the food.
 Exercise: Physical activity and gravity help move food through your digestive
system. Taking a walk, for example, after you eat a meal can help your body
digest the food more easily.
 Avoid alcohol and smoking: Alcohol can increase the amount of acid in your
stomach and can cause heartburn, acid reflux and stomach ulcers. Smoking
almost doubles your risk of having acid reflux. Research has shown that people
who have digestive issues that quit smoking have improved symptoms.
 Manage your stress: Stress is associated with digestive issues such as
constipation, diarrhea and IBS.
 3. Common GI Disorders
 A. Gastroesophageal Reflux Disease (GERD):
• Pathophysiology:
 Lower esophageal sphincter (LES) dysfunction leads to
acid reflux.
• Symptoms:
• Heartburn
• regurgitation
• chest pain
• dysphagia

• Management: PPIs, H2-receptor antagonists,

lifestyle modifications (e.g., weight loss, avoiding
GERD
 Acid reflux happens when the
sphincter muscle at the lower end of
the esophagus relaxes at the wrong
time, allowing stomach acid to back
up into the esophagus. This can
cause heartburn and other
symptoms. Frequent or constant
reflux can lead to GERD.
 is a condition in which stomach acid
repeatedly flows back up into the
tube connecting the mouth and
stomach, called the esophagus. It's
often called GERD for short. This
backwash is known as acid reflux,
and it can irritate the lining of the
esophagus.
B. Peptic Ulcer Disease (PUD):

•Pathophysiology: Erosion of the stomach or

duodenal lining due to excess acid or H. pylori
infection.
•Symptoms
•Abdominal pain
• nausea
•Vomiting
•dyspepsia.
•Management
•Antibiotics for H. pylori, PPIs, antacids, lifestyle
changes (e.g., reducing NSAID use).
PUD
- is a condition that causes ulcers (open sores) to develop in
the lining of your digestive tract. “Peptic” means it’s
related to digestion. The word is derived from pepsin, the
major digestive enzyme that your stomach produces.

- Pepsin and stomach acid - are the active ingredients in

your stomach juices that help to chemically break down
food for digestion. Some of these juices also pass into the
first part of your small intestine (duodenum). By design,
these juices are highly corrosive.

-All of your gastrointestinal tract has a protective mucous lining that

insulates it from the substances inside. It’s especially strong in your
stomach and duodenum.
But in peptic ulcer disease, this protection fails, and digestive juices
corrode through the lining.
An ulcer is an erosion that penetrates through all three layers of the
mucous lining (mucosa). Most peptic ulcers occur in your stomach or
duodenum, where gastric juices are most active. Less commonly,
they can also occur elsewhere in your GI tract.
 PUD
 Peptic ulcer disease is a condition that causes ulcers (open sores) to
develop in the lining of your digestive tract. “Peptic” means it’s
related to digestion. The word is derived from pepsin, the major
digestive enzyme that your stomach produces.
 Pepsin and stomach acid are the active ingredients in your stomach
juices that help to chemically break down food for digestion. Some of
these juices also pass into the
first part of your small intestine (duodenum). By design, these juices
are highly corrosive.
 All of your gastrointestinal tract has a protective mucous lining that
insulates it from the substances inside. It’s especially strong in your
stomach and duodenum. But in peptic ulcer disease, this protection
fails, and digestive juices corrode through the lining.
 An ulcer is an erosion that penetrates through all three layers of the
mucous lining (mucosa). Most peptic ulcers occur in your stomach or
duodenum, where gastric juices are most active. Less commonly,
they can also occur elsewhere in your GI tract.
 PUD
 What are the different types of peptic ulcers?
 Peptic ulcer - disease most often affects your stomach and duodenum.
• Duodenal ulcers - account for almost 80% of peptic ulcers.
• Stomach ulcers - account for almost 20% of peptic ulcers.

 You can get a peptic ulcer elsewhere in your gastrointestinal tract under
unusual circumstances that cause stomach juices to pass through those parts.
Esophageal ulcer - Chronic acid reflux , stomach acid rising into your esophagus ,
may eventually erode the mucous lining in your esophagus enough to cause an
ulcer. Your esophagus lining isn’t as protected against acid as your stomach lining
is.
Jejunal ulcer. You can get an ulcer in your jejunum, the middle part of your small
intestine, as a side effect of surgery connecting your stomach to your jejunum
(gastrojejunostomy). This is also called a stomal ulcer, marginal ulcer
or anastomotic ulcer
PUD
 Symptoms and Causes
 Indigestion - describes a combination of symptoms that occur after eating and during
digestion. It includes epigastric pain with a notable burning quality, combined with a
feeling of fullness that comes on shortly after eating and/or lasts a long time after.
 This burning sensation is the feeling of stomach acids and enzymes eating through
your gastrointestinal lining. Some people also describe it as a “gnawing” sensation.
You may be able to locate it in a particular spot (“focal” abdominal pain).
 Stomach or duodenum Ulcer.
 clues,
 Stomach ulcer - will often feel worse shortly after a meal (within 30 minutes), when
gastric juices are at their peak.
 Duodenal ulcer - may feel better shortly after a meal. But you’ll feel it more about
two to three hours later, when the food and digestive juices enter your duodenum.
Some people interpret this feeling as hunger because eating brings relief.
 Many people with duodenal ulcers report pain that awakens them at night.
This can also occur with jejunal ulcers. Jejunal pain will be a little lower,
closer to your belly button. If you have an esophageal ulcer, it might feel
like heartburn, which peaks at night.
 Cont….PUD
 Other possible symptoms related to peptic ulcer disease include:
 BLOATED STOMACH
 Burping or belching
 LOSS OF APPETITE
 NAUSEA AND VOMITING

 Symptoms of complications
 Blood in your stool (poop)
 Black, tarry stool
 Coffee ground vomitus
 Dizziness or faintness
 Pallor (paleness)
 Rapid heart rate
 Cont…PUD
 Symptoms of a gastrointestinal perforation (hole) may include:
 Sudden, sharp and severe abdominal pain.
 Abdominal swelling and tenderness to touch.
 Fever and chills
Note : If you have untreated peptic ulcer disease for a long time,
ulcers may continuously heal and then start again. Some people
develop so much scarring and/or swelling from untreated ulcers in
their GI tract that it can slow or stop food from moving through.
Symptoms of a gastrointestinal obstruction may include:
Abdominal bloating, swelling and pain.
Nausea and vomiting.
Loss of appetite and weight loss.
Loss of bowel movements and constipation.
 PUD
 Medications
 Peptic ulcer medications include:
 Antibiotics. If you have an H. pylori or other bacterial infection, your healthcare provider
will prescribe some combination of antibiotics to kill the bacteria.
 Common antibiotics for H. pylori infection include:
 Doxycycline.
 Metronidazole.
 Clarithromycin.
 Amoxicillin.
 Cytoprotective agents. These medicines help to coat and protect your gastrointestinal
lining while it heals. They include:
 Sucralfate.
 Misoprostol.
 Bismuth subsalicylate.
Histamine receptor blockers (H2 blockers). These drugs reduce
stomach acid by blocking the chemical that tells your body to produce it.
They include:

Famotidine
Cimetidine
Nizatidine

Proton pump inhibitors (PPIs). These drugs help reduce stomach

acid and also coat and protect your mucous lining to promote healing.
PPIs include

Esomeprazole
Dexlansoprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
Amoxicillin, clarithromycin
(Biaxin), metronidazole
(Flagyl), tetracycline
(Sumycin), or tinidazole
(Tindamax) are likely options.

Proton pump inhibitors (PPIs):

These drugs reduce the acid
in your stomach by blocking
the tiny "pumps," or glands,
that produce it.
OVER DOSAGE OF NSAID
This can affect the chemistry inside
your stomach and duodenum.
NSAIDs inhibit the prostaglandins
that repair damage to your
gastrointestinal lining.
Medical procedures
complicated or bleeding ulcer- your
provider may need to treat it directly, usually
do this during your endoscopy exam.
Providers treat bleeding by cauterizing or
injecting medication into the wound. They’ll
repair a perforation with stitches.
If an ulcer causes an obstruction in your
duodenum or your pyloric channel (the outlet
at the bottom of your stomach), you might
need interventions to reopen the channel.
This might mean suctioning your stomach to
decompress it or, rarely, surgery.
The most important things you can do to prevent peptic ulcer disease are
to:

1.Find and eradicate H. pylori. Most people who have an H. pylori infection
aren’t aware of it. You can find out if you have it by taking a simple urea
breath test. If you have it, you can treat it proactively (before it causes
any problems). If you’ve had it and treated it before, it’s a good idea to
retest because sometimes it comes back.

Interpretation:
Positive Result: Elevated levels of labeled carbon dioxide in the post-
ingestion breath sample indicate the presence of H. pylori.

Negative Result: No significant increase in labeled carbon dioxide levels

suggests the absence of H. pylori.

2. Use NSAIDs only as directed. If you’re in the habit of managing daily

aches and pains with NSAIDs, make sure you aren’t taking more than the
recommended dose. If you’ve already had peptic ulcer disease, you
probably shouldn’t take them at all. But if you have to, you should take
them with another medication to protect your lining.
Inflammatory Bowel Disease
(IBD):
 Types: Crohn’s disease (transmural
inflammation anywhere in the GI tract) and
ulcerative colitis (inflammation limited to
the colon and rectum).
 Symptoms: Abdominal pain, diarrhea,
weight loss, bloody stools.
 Management: Anti-inflammatory
medications, immunosuppressant, dietary
modifications, sometimes surgery.
IBD
Crohn’s disease (transmural inflammation anywhere in the GI tract)

 Crohn's disease is an immunologically mediated chronic inflammatory bowel disease

(autoimmune disorder) of the gastrointestinal (GI) tract that extends along the whole gut wall
thickness, from the mucosa (inner layer) to the serosa (outer layer).
 can advance from mild /moderate inflammatory conditions to severe piercing (fistulisation) or
structuring illness with multiple relapses.
 In Crohn's disease, the immune system targets the gut, resulting in bowel inflammation,
leading to a bowel blockage, severe diarrhoea, painful bowel movements, rectal bleeding, and
other severe symptoms through destruction of the intestinal tissue.
 Common foods that may worsen symptoms include spicy foods, dairy products, alcohol, and
high fiber grains.
 There is currently no cure for Crohn's disease, and there is no single treatment that works for
everyone. One goal of medical treatment is to reduce the inflammation that triggers your signs
and symptoms. Another goal is to improve long-term prognosis by limiting complications
How to diagnose crohns disease and
UC
 Crohn's
disease and ulcerative colitis can be
diagnosed with blood tests, stool tests,
endoscopies, and bowel imaging and
scans.
 There are many treatment options for people
living with IBD including medication, dietary
strategies, surgery, and complementary and
alternative medicine.
 Crons disease
 https://youtu.be/FdJo_eynj8I
 Crohn's disease - is a chronic inflammatory bowel disease (IBD) that can affect
any part of the gastrointestinal (GI) tract, from the mouth to the anus, though it most
commonly affects the end of the small intestine (ileum) and the beginning of the
colon.
 Nursing management for patients with Crohn's disease is comprehensive and focuses
on managing symptoms, promoting nutrition, and providing emotional support.
 Nursing Management of Crohn's Disease
 1. Assessment
 History Taking:
 Document the onset, duration, and severity of symptoms such as abdominal pain, diarrhea,
weight loss, and fatigue.
 Record any family history of Crohn's disease or other inflammatory bowel diseases.
 Review past medical and surgical history, including previous treatments.
 Physical Examination:
 Check for abdominal tenderness, distension, or masses.
 Assess for signs of malnutrition and dehydration.
 Examine the perianal area for fissures, fistulas, or abscesses.
2. Nursing Diagnoses
•Imbalanced Nutrition: Less than Body Requirements related to
malabsorption and dietary restrictions.
•Acute Pain related to intestinal inflammation and ulceration.
•Diarrhea related to inflammation of the intestinal mucosa.
•Risk for Deficient Fluid Volume related to diarrhea and decreased fluid
intake.
•Disturbed Body Image related to chronic illness and possible surgery.
•Anxiety related to chronic illness and fear of exacerbations.

3. Planning and Goals

The patient will achieve and maintain an optimal nutritional status.
The patient will experience relief from pain and discomfort.
The patient will maintain adequate hydration.
The patient will demonstrate effective coping strategies.
The patient will understand the disease process and management
strategies.
4. Interventions
•Nutritional Support:
• Collaborate with a dietitian to create a high-calorie, high-protein diet that is low
in residue and lactose-free if needed.
• Encourage small, frequent meals.
• Monitor weight and nutritional intake regularly.
• Administer vitamin and mineral supplements as prescribed.
• In severe cases, consider enteral or parenteral nutrition.
Foods to Increase in Your Diet
•Fruits: bananas, raspberries, applesauce, blended fruit.
•Vegetables: squashes, fork-tender cooked carrots, green beans.
•Foods rich in omega 3 fatty acids: fatty fish (salmon, tuna, mackerel, etc.), walnut
butter, chia seeds, flaxseed oil, flaxseed meal

•Pain Management:
• Administer prescribed medications, such as anti-inflammatory drugs,
immunosuppressants, and biologics.
• Utilize non-pharmacological pain relief methods, such as relaxation techniques
and heat application.
•Fluid and Electrolyte Balance:
• Monitor fluid intake and output, including stool output.
• Encourage oral fluids and administer IV fluids as needed to prevent dehydration.
•Medication Administration:
•Ensure the patient understands the purpose, dosage, and potential side effects of medications.
•Educate the patient on the importance of medication adherence.

•Patient Education:
•Educate the patient about the nature of Crohn's disease, including potential triggers and the importance of medication
adherence.
•Teach dietary modifications and the avoidance of foods that may exacerbate symptoms.
•Provide information on stress management techniques, as stress can worsen symptoms.
•Instruct the patient on the importance of regular follow-up appointments and monitoring of symptoms.

•Emotional Support:
•Provide a supportive environment where the patient feels comfortable discussing their concerns and fears.
•Encourage the patient to join support groups or counseling to cope with the chronic nature of the disease.

•Monitoring and Early Detection of Complications:

•Regularly assess for signs of complications such as bowel obstruction, abscesses, or fistulas.
•Educate the patient on the symptoms that require immediate medical attention.
5. Evaluation
•Regularly reassess the patient's nutritional
status, pain levels, fluid balance, and overall well-
being.
•Evaluate the patient's understanding and
adherence to the treatment plan.
•Adjust the care plan based on the patient's
response to interventions and any changes in their
condition.
IBD
Ulcerative colitis
 Ulcerative colitis (UC) is a chronic inflammatory bowel disease
(IBD) that primarily affects the colon and rectum, leading to
inflammation and ulceration of the intestinal lining. The
management of UC in nursing involves a holistic approach to
address symptoms, promote remission, and improve the
patient’s quality of life.

 https://youtu.be/rjlYDXRN1zQ
 IBD
Ulcerative colitis
 Nursing Management of Ulcerative Colitis
 1. Assessment
• History Taking:
• Document the onset, duration, and severity of symptoms such as bloody
diarrhea, abdominal pain, urgency, and tenesmus.
• Assess for systemic symptoms like fever, fatigue, and weight loss.
• Review past medical and surgical history, including previous flares and
treatments.
• Physical Examination:
• Assess for signs of dehydration, malnutrition, and abdominal tenderness.
• Monitor for extraintestinal manifestations such as arthritis, skin lesions, or eye
inflammation.
2. Nursing Diagnoses

•Diarrhea related to inflammation of the bowel mucosa.

•Acute Pain related to intestinal cramping and inflammation.
•Imbalanced Nutrition: Less than Body Requirements related to
malabsorption and dietary restrictions.
•Risk for Deficient Fluid Volume related to diarrhea and decreased oral
intake.
•Anxiety related to chronic illness and fear of exacerbations.
•Disturbed Body Image related to chronic disease and potential surgery.

3. Planning and Goals

The patient will achieve and maintain optimal nutritional status.

The patient will experience relief from pain and discomfort.
The patient will maintain adequate hydration.
The patient will demonstrate effective coping strategies.
The patient will understand the disease process and management strategies.
3. Planning and Goals

•The patient will achieve and maintain

optimal nutritional status.
•The patient will experience relief from pain
and discomfort.
•The patient will maintain adequate
hydration.
•The patient will demonstrate effective
coping strategies.
•The patient will understand the disease
process and management strategies.
4. Interventions
•Nutritional Support:
• Collaborate with a dietitian to develop a balanced, nutrient-rich diet.
• Encourage small, frequent meals that are easy to digest.
• Recommend avoiding foods that can exacerbate symptoms, such as high-fiber foods, dairy,
and spicy foods.
• Monitor weight and nutritional intake regularly.
• Administer vitamin and mineral supplements as prescribed.
•Pain Management:
• Administer prescribed medications, including anti-inflammatory drugs, immunosuppressants,
and biologics.
• Utilize non-pharmacological pain relief methods, such as relaxation techniques and heat
application.
•Fluid and Electrolyte Balance:
• Monitor fluid intake and output, including stool frequency and consistency.
• Encourage oral hydration and administer IV fluids as needed to prevent dehydration.
• Monitor for signs of electrolyte imbalances and administer replacements as necessary.
•Medication Administration:
• Ensure the patient understands the purpose, dosage, and potential side effects of medications.
• Educate the patient on the importance of medication adherence.
•Patient Education:
• Provide information about the nature of UC, including potential triggers and the
importance of medication adherence.
• Teach dietary modifications and the avoidance of foods that may exacerbate symptoms.
• Provide information on stress management techniques, as stress can worsen symptoms.
• Instruct the patient on the importance of regular follow-up appointments and monitoring
of symptoms.
•Emotional Support:
• Provide a supportive environment where the patient feels comfortable discussing their
concerns and fears.
• Encourage the patient to join support groups or counseling to cope with the chronic
nature of the disease.
•Monitoring and Early Detection of Complications:
• Regularly assess for signs of complications such as bowel obstruction, toxic megacolon,
or perforation.
• Educate the patient on the symptoms that require immediate medical attention.
5. Evaluation
•Regularly reassess the patient’s
nutritional status, pain levels, fluid
balance, and overall well-being.
•Evaluate the patient’s understanding
and adherence to the treatment plan.
•Adjust the care plan based on the
patient’s response to interventions and
any changes in their condition.
Dietary Recommendations for
Ulcerative Colitis
1. General Guidelines
•Small, Frequent Meals: Eat smaller, more
frequent meals throughout the day to avoid
overloading the digestive system.

•Stay Hydrated: Drink plenty of fluids,

primarily water, to prevent dehydration caused
by diarrhea.

•Low-Fiber Foods: During flare-ups, consume

low-fiber foods to reduce bowel movement
frequency and irritation.

•Balanced Diet: Ensure a well-balanced diet

to maintain proper nutrition and prevent
2. Foods to Include

•Low-Fiber Vegetables:
• Well-cooked carrots, potatoes (without skin), and squash.
• Pureed or peeled vegetables.
•Lean Proteins:
• Skinless chicken, turkey, and lean cuts of pork or beef.
• Fish and shellfish.
• Eggs.
•Refined Grains:
• White rice, plain pasta, and noodles.
• White bread and refined cereals.
• Oatmeal and cream of wheat (if well-tolerated).
•Dairy Alternatives:
• Lactose-free milk, almond milk, rice milk, and other non-dairy alternatives.
• Hard cheeses and yogurt with live cultures (if tolerated).
•Fruits:
• Peeled and cooked fruits like applesauce and ripe bananas.
• Canned fruits in their own juice or light syrup.
•Fats:
• Small amounts of healthy fats, such as olive oil, avocado, and nut butters (if
tolerated).
3. Foods to Avoid

•High-Fiber Foods:
• Raw vegetables and fruits with skins and seeds.
• Whole grains, nuts, seeds, and legumes.
•Dairy Products:
• Milk, soft cheeses, and ice cream (for those who are lactose
intolerant).
•Spicy Foods:
• Foods containing hot peppers, chili powder, and other spices.
•Fried and Fatty Foods:
• Deep-fried foods, greasy snacks, and fatty cuts of meat.
•Caffeinated Beverages:
• Coffee, tea, and caffeinated sodas.
•Carbonated Drinks:
• Sodas and sparkling water.
•Alcohol:
• Beer, wine, and spirits.
4. Special Considerations

•Individual Tolerance: Each patient’s tolerance to

foods can vary, so it is important to keep a food diary
to track which foods trigger symptoms.
•Nutritional Supplements: Patients may need
supplements to address deficiencies, such as iron,
calcium, vitamin D, and B vitamins. Always consult a
healthcare provider before starting supplements.
•Dietary Fiber: Gradually reintroduce low-fiber foods
during remission, paying attention to the body’s
response.
•Consult a Dietitian: Work with a dietitian to
develop a personalized eating plan that meets
nutritional needs and manages symptoms effectively.
Sample Meal Plan for a Day
Breakfast
•Scrambled eggs.
•White toast with a small amount of butter or jam.
•A banana (if well-tolerated).
•Lactose-free milk or a dairy alternative.
Mid-Morning Snack
•Applesauce.
•Herbal tea or water.
Lunch
•Grilled chicken breast.
•Mashed potatoes (without skin).
•Cooked carrots.
•White bread.
Afternoon Snack
•Plain yogurt with live cultures (if tolerated).
•A handful of peeled and steamed apple slices.
Dinner
•Baked fish (e.g., cod or tilapia).
•White rice.
•Cooked zucchini (peeled).
•A slice of white bread.
Evening Snack
•Rice cakes or crackers.
Irritable Bowel Syndrome (IBS):

Pathophysiology: Functional GI
disorder with no structural
abnormalities; related to stress and diet.
Symptoms: Abdominal pain, bloating,
diarrhea, constipation.
Management: Dietary adjustments
(e.g., low FODMAP diet), stress
management, medications.
A low FODMAP diet is a dietary plan designed to help individuals manage symptoms of
irritable bowel syndrome (IBS) and other functional gastrointestinal disorders. FODMAPs
are a group of short-chain carbohydrates and sugar alcohols that are poorly absorbed in
the small intestine. The acronym FODMAP stands for:

•Fermentable: Sugars that are fermented by gut

bacteria.
•Oligosaccharides: Found in foods such as wheat,
onions, and garlic.
•Disaccharides: Found in foods such as lactose in milk,
yogurt, and soft cheese.
•Monosaccharides: Found in foods such as fructose in
honey, apples, and high-fructose corn syrup.
•Polyols: Found in foods such as sorbitol and mannitol
in stone fruits and artificial sweeteners.
Purpose of a Low FODMAP Diet
The low FODMAP diet aims to reduce the intake of
these fermentable carbohydrates to decrease
gastrointestinal symptoms such as bloating, gas,
abdominal pain, and diarrhea.

This diet is typically followed in three phases:

1.Elimination Phase: All high FODMAP foods are eliminated from
the diet for 4-6 weeks.
2.Reintroduction Phase: High FODMAP foods are gradually
reintroduced one at a time to identify which types and amounts of
FODMAPs trigger symptoms.
3.Personalization Phase: A personalized, long-term eating plan is
developed based on the individual's tolerance to different FODMAPs
 IBS is a common functional
gastrointestinal disorder
characterized by chronic abdominal
pain, discomfort, bloating, and
altered bowel habits (constipation,
diarrhea, or both).
As a nurse, managing patients with
IBS involves a comprehensive
approach that includes assessment,
patient education, symptom
management, and support.
IBS AND IBD

 IBS is a disorder of the  IBD is inflammation or

gastrointestinal (GI) tract. destruction of the bowel wall,
which can lead to sores and
narrowing of the intestines
Liver Diseases:

 Hepatitis: Inflammation of the liver due to viral infections, alcohol, or

autoimmune conditions.
 Cirrhosis: Chronic liver damage leading to fibrosis and impaired function.
 Symptoms: Jaundice, ascites, encephalopathy.
 Management: Address underlying causes (e.g., antiviral drugs,
abstaining from alcohol),
Pancreatitis:

 Pathophysiology: Inflammation of the pancreas, often due to gallstones

or chronic alcohol use.
 Symptoms: Severe abdominal pain, nausea, vomiting, elevated serum
amylase and lipase.
 Management: Pain control, fluid resuscitation, fasting (bowel rest),
addressing underlying causes.
 Pancreatitis:
 4. Assessment and Diagnosis
 Patient History:
 Detailed Symptom Assessment: Onset, duration, and characteristics of symptoms; dietary
habits; medication and substance use history.
 Family History: Genetic predisposition to GI disorders.
 Physical Examination:
 Inspection: Observe for signs of distension, jaundice, or abnormal pulsations.
 Palpation: Assess for tenderness, masses, or organ enlargement.
 Percussion: Detect fluid, gas, or organ size.
 Auscultation: Listen for bowel sounds, which can indicate bowel activity or obstruction.
 Diagnostic Tests:
 Laboratory Tests: CBC, liver function tests (LFTs), stool tests for occult blood or pathogens.
 Imaging Studies: Abdominal ultrasound, CT scan, MRI to visualize organs and detect
abnormalities.
 Endoscopy/Colonoscopy: Direct visualization of the GI tract for diagnosis and biopsy.
 5. Nursing Interventions
 Medication Management:
 Antacids/PPIs: To reduce gastric acid and treat GERD and ulcers.
 Antidiarrheals/Laxatives: To manage IBS symptoms or constipation.
 Antibiotics: To treat infections or eradicate H. pylori.
 Dietary Management:
 Nutritional Assessment: Tailoring diets to specific conditions (e.g., low-residue diet
for IBD).
 Hydration: Monitoring fluid balance to prevent dehydration.
 Patient Education:
 Disease Process and Management: Explaining conditions and treatment plans.
 Lifestyle Modifications: Diet, smoking cessation, alcohol moderation.
 Medication Adherence: Instructions on taking medications and recognizing side
effects.
6. Monitoring and Evaluation
 Ongoing Assessment:
o Symptom Monitoring: Regular checks on symptom control and adverse effects.
o Complication Watch: Identify signs of complications such as bleeding, dehydration, or
liver failure.
 Patient Feedback:
o Evaluate Understanding: Ensure the patient comprehends their condition and treatment
plan.
o Adjust Care Plans: Modify interventions based on patient progress and feedback.
7. Case Study Example
Scenario: A 45-year-old patient presents with chronic abdominal pain, bloating, and
diarrhea. They have a history of frequent NSAID use.
Assessment: Detailed history including NSAID use, physical examination, and
diagnostic tests (e.g., endoscopy for potential ulcers).
Diagnosis: Likely peptic ulcer disease.
Intervention: Discontinue NSAIDs, initiate PPIs, provide education on diet and
lifestyle changes, and monitor for symptom improvement.
Key Points to Remember
 Individualized Care: Tailor treatment to each patient’s specific condition and
needs.
 Holistic Approach: Address both physical and emotional aspects of care.
 Continual Learning: Stay updated with the latest research and guidelines in GI
nursing.